Effects of different payment methods on perinatal care outcomes: a systematic review.

BACKGROUND

Respectful maternity care in healthcare facilities during childbirth is a growing concern around the world. It is more than just an important component of care quality; it is also a human right. The aim of this study was to develop and validate a tool to assess respectful maternity care practices among healthcare providers in Nepal.

METHODS

We systematically searched primary studies published until May 2023, adhering to PRISMA guidelines. Studies evaluating causal effects of payment methods on perinatal outcomes were included. Quality was assessed using the JBI-MAStARI tools. Due to heterogeneity in the studies, a meta-analysis was not feasible; findings were summarized narratively and presented in tables/ figures.

RESULTS

Fifty-three studies were included, focusing on prenatal care (62%), childbirth (28%), and NICU care (10%). Pay-for-performance (P4P) methods improved institutional deliveries and reduced costs but had minimal effects on prenatal care quality. Diagnosis-Related Groups (DRGs) methods reduced cesarean rates but increased complications compared to Fee-For-Service (FFS). Bundled payments lowered cesarean rates and costs, while blended methods also reduced rates but increased postpartum hemorrhage. In NICU care, DRG methods increased the length of stay (LoS) and costs, primarily due to upcoding.

CONCLUSION

The effectiveness of payment methods depends heavily on their design, implementation, and context. Poorly designed programs, despite their potential, can lead to adverse outcomes. Further research is needed to develop effective and equitable payment models that sustainably enhance maternal and neonatal health outcomes.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1186/s12913-025-13160-3.